UnitedHealth Under Investigation for Medicare Billing: What It Means for Seniors?

UnitedHealth Medicare Fraud: UnitedHealth Group, the company that owns the largest private health insurance in America, is now in the middle of serious legal trouble. Both civil and criminal investigations by the U.S. Department of Justice (DOJ) are happening right now. The government is looking into whether UnitedHealth did something wrong with its billing under the Medicare Advantage program. This is a huge deal because Medicare Advantage brings in a lot of money for UnitedHealth $139 billion just last year from their Medicare and retirement section.

UnitedHealth has confirmed in a public filing that they are working with the DOJ. They’ve also started their own independent review using a third party to check their rules and computer systems. This review should finish before the third quarter ends. The company said in its filing, “The company has full confidence in its practices and is committed to working cooperatively with the Department throughout this process.”

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Before now, UnitedHealth kept denying any federal investigation. But things changed in May when a Wall Street Journal report said that DOJ was already digging into their billing practices. That report claimed the DOJ talked to several doctors about whether UnitedHealth made them feel pushed to write down more serious diagnoses. If that happened, it would mean more government money flowing to UnitedHealth, because Medicare Advantage gives more money for sicker patients.

What Are They Being Accused Of?

The issue centers around how Medicare Advantage works. It pays private insurers more for patients who are sicker. So, if a company reports more serious health conditions, they can get more money from the government. The DOJ wants to know if UnitedHealth used this to their advantage by making diagnoses look worse than they really were.

Back in February, the Wall Street Journal said the DOJ had already started another civil investigation to look at whether the company gave out overly dramatic diagnoses to get extra payments. UnitedHealth has said they didn’t do anything wrong. They pointed to audits done by the Centers for Medicare and Medicaid Services (CMS) that showed their billing methods are “among the most accurate in the industry.”

They also mentioned a special master who reviewed a whistleblower case where UnitedHealth was accused of keeping over $2 billion in Medicare payments it shouldn’t have had. In March, the special master said the DOJ didn’t have enough proof to back up those claims.

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Still, the problems are affecting UnitedHealth’s stock badly. After they filed the paperwork about the investigation, their stock dropped about 2%. That’s not all—UnitedHealth’s stock has already gone down over 42% this year. The company has been hit hard by high medical costs, a major cyberattack, and now, leadership changes.

Leadership Crisi

On top of all this, UnitedHealth has been dealing with chaos in its leadership. In May, their CEO Andrew Witty suddenly stepped down. This came after a very rocky time for the company that started when UnitedHealthcare CEO Brian Thompson was murdered in New York City.

A Shocking Murder Case

A 26-year-old named Luigi Mangione was charged with the murder. He has denied all the charges, including murder in furtherance of terrorism and multiple weapons crimes. The police say they found a backpack with a gun and a manifesto where the suspect talked about health insurance bosses being full of “corruption and greed.” Mangione is not expected to go to trial until 2026 and he is still in jail.